On death and dying: The Liverpool Care Pathway

[XB9S, BSN, MSN, EdD, RN, APN]

The Liverpool Care Pathway (LCP) is widely used, and recognised as best practice when caring for patients who are end of life. It aim is to guide the multi-disciplinary team in areas such as discontinuation of fluids, medicines and the pathway gives guidence around comfort measures during the last days and hours of life.

Organsised into sections, it has provided consistency, support and guidence for those who make use of it to promote and ensure a comfortable, dignified death.

http://www.liv.ac.uk/mcpcil/liverpool-care-pathway/

In recent months there has been a great deal of scrutiny around the use of the pathway, orginanating from a Daily Mail article by Melanie Phillips who suggested that the pathway has been used to expidite death and without the full knowledge of relatives of dying patients. (I must warn the reader, the Daily Mail is a tabloid paper reknown for it's condemnation of the National Health Service and the UK healthcare workers)

http://www.dailymail.co.uk/news/article-2225009/The-medical-professions-lethal-arrogance-Liverpool-Care-Pathway.html

The original article has caused great anxiety within the healthcare world, not because the information provided is correct but because the scaremongering tactics of this tabloid could potentially lead to end of life patients being denied best practice and subjected to painful, prolonged deaths.

There have been concerns voiced on medical forums, in the British Medical Journal and via facebook fictional characters such as the "Medical Registrar", "the Palliative Care registrar" and "the Consultant Vascular Surgeon"

I have used the pathway on many occasions, and in fact have on a number of occasions initiated it's use with discussions with the medical teams. I have only once had the experience of a patient who survived after being put on the pathway, it was discontinued when she showed signs of improvment (she was an elderly lady who had fallen, fractured her ribs, had a splenic bleed and had a multitude of chronic illness' ) It was felt she was unlikely to survive.

http://www.nhs.uk/news/2012/11November/Pages/What-is-the-Liverpool-Care-Pathway.aspx

In response to the Daily Mail's article the government has responded, demanding that investigations be carried out in areas that have been named as having poor practice, there is a suggestion that healthcare organisations receive money for putting patients on the pathway, there has been an overwhelming response from medics stating that the care pathway is used after full clinical assessment and where the patient is felt to be in the last days of life.

http://www.nhs.uk/news/2012/11November/Pages/What-is-the-Liverpool-Care-Pathway.aspx

There are now genuine concerns that if healthcare professionals suggest the care pathway to families of patients who are felt to be end of life, there will be fear, misunderstanding and there is the real risk that patients will suffer as a result.